Small Area Variations in Out-of-Hospital Cardiac Arrest: Does the Neighborhood Matter?

Published in: Annals of Internal Medicine, v. 153, no. 1, July 2010, p. 19-22, w-9-w12

Posted on RAND.org on July 01, 2010

by Comilla Sasson, Carla C. Keirns, Dylan Smith, Michael Sayre, William Macy, William Meurer, Bryan F. McNally, Arthur L. Kellermann, Theodore J. Iwashyna

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BACKGROUND: The incidence and outcomes of out-of-hospital cardiac arrest vary widely across cities. It is unknown whether similar differences exist at the neighborhood level. Objective: To determine the extent to which neighborhoods have persistently high rates of cardiac arrest but low rates of bystander cardiopulmonary resuscitation (CPR). DESIGN: Multilevel Poisson regression of 1108 cardiac arrests from 161 census tracts as captured by the Cardiac Arrest Registry to Enhance Survival (CARES). Setting: Fulton County, Georgia, between 1 October 2005 to 30 November 2008. MEASUREMENTS: Incidence of cardiac arrest, by census tract and year and by rates of bystander CPR. RESULTS: Adjusted rates of cardiac arrest varied across neighborhoods (interquartile range [IQR], 0.57 to 0.73 per 1000 persons; mean, 0.64 per 1000 persons [SD, 0.11]) but were stable from year to year (intraclass correlation, 0.36 [95% CI, 0.26 to 0.50]; P < 0.001). Adjusted bystander CPR rates also varied by census tract (IQR, 19% to 29%; mean, 25% [SD, 10%]). LIMITATION: Analysis was based on data from a single county. CONCLUSION: Surveillance data can identify neighborhoods with a persistently high incidence of cardiac arrest and low rates of bystander CPR. These neighborhoods are promising targets for community-based interventions.

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